Psychiatric Disorders, Psychotropics, and Falls Among Women
Psychiatric Disorders, Psychotropics, and Falls Among Women
Data were derived from an age-stratified, population-based sample of women enrolled in the Geelong Osteoporosis Study (GOS). Originally, 1,494 women (aged 20–94 yr, response 77.1%) were randomly recruited from the electoral rolls for the Barwon Statistical Division (south-eastern Australia) between 1994 and 1997 and have returned for ongoing assessment. Between 2004 and 2008, 881 of the original sample returned for a 10-year follow-up assessment (participation 82.1%) and an additional sample of 246 women aged 20–29 years was recruited (participation 70.9%), allowing for continuing investigation of the full adult age range. Of the 1127 women who participated in the GOS during 2004–2008, participants for whom psychiatric data were not available for this phase (n = 32), did not return their questionnaire (n = 10), were unable to recall year of last psychiatric episode (n = 2), and were current users of anticonvulsant (n = 13) and antipsychotic medications (n = 8), were excluded, resulting in a sample of 1062 women aged 20–93 yr eligible for this analysis. All participants gave written, informed consent, and the study was approved by the Human Research Ethics Committee at Barwon Health.
Outcome Variable. The number of falls occurring during the 12-months prior to the study assessment (2004–2008) was documented by self-report questionnaire. The definition "when you suddenly find yourself on the ground, without intending to get there, after you were in either a lying, sitting or standing position" was used to determine a fall. For this analysis, participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period.
Exposure Variables. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient edition (SCID-I/NP) was used to assess lifetime history of depressive disorders, including major depressive disorder (MDD), minor depression, bipolar disorder, dysthymia, mood disorder due to a general medical condition, and substance induced mood disorder and anxiety disorders, including panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, generalised anxiety disorder, anxiety disorders due to a general medical condition, substance induced anxiety disorder and anxiety disorders not otherwise specified. Participants were classified as having 12-month, past (prior to 12-month), or no history of depressive or anxiety disorders. Trained personnel, with qualifications in psychology, conducted all psychiatric interviews.
Antidepressant and benzodiazepine use was self-reported and was deemed current if used regularly at the time of assessment. Participants were asked to bring in a list of medications or containers to assist with accurate recording of details.
Weight was measured to the nearest 0.1 kg. Information on lifestyle and other health factors was obtained via questionnaire. Mobility was classified as active if vigorous or light exercise was performed regularly, sedentary if normal day to day living is achieved but no appreciable exercise, and limited if activity was restricted to the point of little walking outside of the home, sits in chair or lies in bed most of the time, or bedridden. Use of a walking aid was determined by the question "Do you use a walking aid" (Yes/No). Current health status was measured using a self-report 5-point Likert self-report scale ranging from 1 (Excellent) to 5 (Poor). Alcohol and calcium intake was estimated from a validated food frequency questionnaire and current smoking status ("How many cigarettes do you have each day?") was documented. Socio-economic status (SES) was ascertained using Socio-Economic Index For Areas (SEIFA) index scores, based on the 2006 Australian Bureau of Statistics Census data; SEIFA scores were used to determine the level of SES via the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). The IRSAD accounts for parameters measured at the area-level, including high and low income, and type of occupation. A low score using the IRSAD identifies the most disadvantaged (quintile 1), while a high score identifies the most advantaged (quintile 5). Blood pressure was measured (seated) with a digital meter (A&D Company, model UA-751).
Statistics. Differences in characteristics between those with 12 month, past or no history of depression or anxiety were determined using analysis of variance (ANOVA), with Tukey's Test Statistic for multiple comparisons applied, for continuous variables, Kruskal-Wallis for non-parametric continuous variables, and the chi square test for discrete variables. Post hoc analyses were conducted where appropriate. Logistic regression was used to calculate odds ratios (OR) with 95% confidence interval (95% CI) for falls for those with 12-month and past depression in comparison to those with no depression. The relationship between falls and anxiety disorders (12-month/past/never), were similarly investigated. Covariates included age, weight, psychotropic medication, smoking status, blood pressure, mobility, use of a walking aid, health status, SES, alcohol consumption and calcium intake. These were tested sequentially and only included in the final model if significant. In addition to these covariates, depressive and anxiety disorders were tested when exploring the association between falls and use of any psychotropic medication, antidepressants and benzodiazepines. All interactions were tested. Statistical analyses were performed using Minitab (Version 16; Minitab, State College Pa) and SPSS statistical package 22.0 for Windows (SPSS Inc., Chicago, IL, USA).
Methods
Participants
Data were derived from an age-stratified, population-based sample of women enrolled in the Geelong Osteoporosis Study (GOS). Originally, 1,494 women (aged 20–94 yr, response 77.1%) were randomly recruited from the electoral rolls for the Barwon Statistical Division (south-eastern Australia) between 1994 and 1997 and have returned for ongoing assessment. Between 2004 and 2008, 881 of the original sample returned for a 10-year follow-up assessment (participation 82.1%) and an additional sample of 246 women aged 20–29 years was recruited (participation 70.9%), allowing for continuing investigation of the full adult age range. Of the 1127 women who participated in the GOS during 2004–2008, participants for whom psychiatric data were not available for this phase (n = 32), did not return their questionnaire (n = 10), were unable to recall year of last psychiatric episode (n = 2), and were current users of anticonvulsant (n = 13) and antipsychotic medications (n = 8), were excluded, resulting in a sample of 1062 women aged 20–93 yr eligible for this analysis. All participants gave written, informed consent, and the study was approved by the Human Research Ethics Committee at Barwon Health.
Measurements
Outcome Variable. The number of falls occurring during the 12-months prior to the study assessment (2004–2008) was documented by self-report questionnaire. The definition "when you suddenly find yourself on the ground, without intending to get there, after you were in either a lying, sitting or standing position" was used to determine a fall. For this analysis, participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period.
Exposure Variables. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient edition (SCID-I/NP) was used to assess lifetime history of depressive disorders, including major depressive disorder (MDD), minor depression, bipolar disorder, dysthymia, mood disorder due to a general medical condition, and substance induced mood disorder and anxiety disorders, including panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, generalised anxiety disorder, anxiety disorders due to a general medical condition, substance induced anxiety disorder and anxiety disorders not otherwise specified. Participants were classified as having 12-month, past (prior to 12-month), or no history of depressive or anxiety disorders. Trained personnel, with qualifications in psychology, conducted all psychiatric interviews.
Antidepressant and benzodiazepine use was self-reported and was deemed current if used regularly at the time of assessment. Participants were asked to bring in a list of medications or containers to assist with accurate recording of details.
Weight was measured to the nearest 0.1 kg. Information on lifestyle and other health factors was obtained via questionnaire. Mobility was classified as active if vigorous or light exercise was performed regularly, sedentary if normal day to day living is achieved but no appreciable exercise, and limited if activity was restricted to the point of little walking outside of the home, sits in chair or lies in bed most of the time, or bedridden. Use of a walking aid was determined by the question "Do you use a walking aid" (Yes/No). Current health status was measured using a self-report 5-point Likert self-report scale ranging from 1 (Excellent) to 5 (Poor). Alcohol and calcium intake was estimated from a validated food frequency questionnaire and current smoking status ("How many cigarettes do you have each day?") was documented. Socio-economic status (SES) was ascertained using Socio-Economic Index For Areas (SEIFA) index scores, based on the 2006 Australian Bureau of Statistics Census data; SEIFA scores were used to determine the level of SES via the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). The IRSAD accounts for parameters measured at the area-level, including high and low income, and type of occupation. A low score using the IRSAD identifies the most disadvantaged (quintile 1), while a high score identifies the most advantaged (quintile 5). Blood pressure was measured (seated) with a digital meter (A&D Company, model UA-751).
Statistics. Differences in characteristics between those with 12 month, past or no history of depression or anxiety were determined using analysis of variance (ANOVA), with Tukey's Test Statistic for multiple comparisons applied, for continuous variables, Kruskal-Wallis for non-parametric continuous variables, and the chi square test for discrete variables. Post hoc analyses were conducted where appropriate. Logistic regression was used to calculate odds ratios (OR) with 95% confidence interval (95% CI) for falls for those with 12-month and past depression in comparison to those with no depression. The relationship between falls and anxiety disorders (12-month/past/never), were similarly investigated. Covariates included age, weight, psychotropic medication, smoking status, blood pressure, mobility, use of a walking aid, health status, SES, alcohol consumption and calcium intake. These were tested sequentially and only included in the final model if significant. In addition to these covariates, depressive and anxiety disorders were tested when exploring the association between falls and use of any psychotropic medication, antidepressants and benzodiazepines. All interactions were tested. Statistical analyses were performed using Minitab (Version 16; Minitab, State College Pa) and SPSS statistical package 22.0 for Windows (SPSS Inc., Chicago, IL, USA).